Platzer M, Likar R, Stettner H, Jost R, Wutti C, Leipold H, Breschan C
Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt/Wörthersee, Klagenfurt, Austria.
Anaesthesist. 2011 Jul;60(7):625-32. doi: 10.1007/s00101-011-1855-6. Epub 2011 May 15.
The primary aim of this study was to determine whether the combination of i.v. ketoprofen and i.v. paracetamol provides superior postoperative analgesia in children undergoing adenoidectomy or tonsillotomy compared to either drug alone. The secondary goal was to assess the time until rescue analgesia was needed, propofol requirements and the incidence of vomiting and time of discharge from the postanaesthesia recovery unit (PARU).
This double-blinded study included 120 children (aged 3-13 years) scheduled for elective tonsillectomy, adenoidectomy or adenotonsillectomy. The children were randomly assigned to one of 3 groups of 40 children each, using the sealed envelope method. The children received i.v. ketoprofen 2 mg/kgBW (group 1) or paracetamol 15 mg/kgBW (group 2) or the combination of these 2 drugs (group 3) after induction of anaesthesia. Standardized general anaesthesia consisted of sevoflurane and fentanyl at a dose of 2-3 μg/kgBW. Pain was assessed using a 5-point scoring system based on the Smiley scale. The Smiley scale shows various faces from a laughing face which corresponds to the state of no pain to a very unhappy face which corresponds to the situation of worst pain (1: no pain, 2: mild pain, 3: moderate pain, 4: severe pain, 5: worst pain). Pain was assessed at 30 min, 1 h, 2 h, 3 h and 4 h after arriving in the PACU. If the pain score exceeded 2 an i.v. dose of 0.1 mg/kgBW morphine was administered as rescue analgesia.
During the stay in the PACU the children in the combination group required significantly less supplementary rescue analgesia than children in the ketoprofen and paracetamol groups (17.5% versus 30.8% versus 45%, respectively, χ(2) analysis <0.05). Pain scoring was highest after paracetamol, however, this difference was only significant when compared to the group receiving the combination of paracetamol and ketoprofen (U-test p<0.05). Rescue analgesia was administered earliest in group 2 (paracetamol) reaching statistical significance, however, only when compared to group 3 (logrank test p<0.05). Propofol requirements and time to discharge from the PACU did not differ significantly between the 3 groups (χ(2) analysis; U-test; p>0.05). The overall incidence of vomiting was very low in this study with 6.4% (9/139). Significantly more children in the paracetamol group compared to ketoprofen group and combination group suffered from vomiting (17.5% versus 2.6% versus 2.5%; χ(2) analysis; p<0.05). The time to discharge from PACU did not differ significantly between the 3 groups (U-test: p>0.05).
The combination of i.v. paracetamol and i.v. ketoprofen provides superior postoperative analgesia compared to the single use of paracetamol.
本研究的主要目的是确定静脉注射酮洛芬和静脉注射对乙酰氨基酚联合使用，与单独使用这两种药物相比，是否能为接受腺样体切除术或扁桃体切除术的儿童提供更优的术后镇痛效果。次要目标是评估至需要补救性镇痛的时间、丙泊酚需求量、呕吐发生率以及从麻醉后恢复室（PARU）出院的时间。
这项双盲研究纳入了120名计划接受择期扁桃体切除术、腺样体切除术或腺扁桃体切除术的儿童（3至13岁）。采用密封信封法将儿童随机分为3组，每组40名。麻醉诱导后，儿童分别接受静脉注射酮洛芬2mg/kg体重（第1组）、对乙酰氨基酚15mg/kg体重（第2组）或这两种药物的联合使用（第3组）。标准化全身麻醉由七氟醚和剂量为2 - 3μg/kg体重的芬太尼组成。使用基于笑脸量表的5分评分系统评估疼痛。笑脸量表展示了从对应无痛状态的笑脸到对应最痛情况的非常不开心的脸等各种表情（1：无痛，2：轻度疼痛，3：中度疼痛，4：重度疼痛，5：最痛）。在进入麻醉后护理单元（PACU）后30分钟、1小时、2小时、3小时和4小时评估疼痛。如果疼痛评分超过2分，则静脉注射0.1mg/kg体重的吗啡作为补救性镇痛。
在PACU停留期间，联合用药组儿童所需的补充性补救性镇痛明显少于酮洛芬组和对乙酰氨基酚组儿童（分别为17.5%、30.8%和45%，χ²分析<0.05）。对乙酰氨基酚组的疼痛评分最高，然而，仅与接受对乙酰氨基酚和酮洛芬联合用药的组相比时，这种差异才有统计学意义（U检验p<0.05）。第2组（对乙酰氨基酚组）最早给予补救性镇痛，具有统计学意义，但仅与第3组相比时（对数秩检验p<0.05）。3组之间丙泊酚需求量和从PACU出院的时间无显著差异（χ²分析；U检验；p>0.05）。本研究中呕吐的总体发生率非常低，为6.4%（9/139）。与酮洛芬组和联合用药组相比，对乙酰氨基酚组有更多儿童出现呕吐（分别为17.5%、2.6%和2.5%；χ²分析；p<0.05）。3组之间从PACU出院的时间无显著差异（U检验：p>0.05）。
与单独使用对乙酰氨基酚相比，静脉注射对乙酰氨基酚和静脉注射酮洛芬联合使用可提供更优的术后镇痛效果。
